Dry eyes are often overlooked in children because it occurs less frequently than in adults, but it should be taken seriously because it can be related to an underlying problem. Dry eyes or keratoconjunctivitis sicca is one of the most common diagnoses made by Optometrists and Ophthalmologists.

When the cornea, the transparent and sensitive outside window to the eye, is not adequately lubricated, corneal cells are damaged which exposes its nerve endings. This causes the typical dry eye symptoms of pain and reflex tearing.  If the nerves become severely damaged, they may get to the point where you unable to feel or transmit pain which means there will be few, or no symptoms. This is dangerous because without a warning system,  it is like your hand not being able to feel pain if you put it into a fire, which would alert you to avoid the dangerous situation.

Dry Eye Symptoms

Symptoms of dry eyes include:

• burning, scratchy sensation
• eyes feel tired
• red or bloodshot eyes
• rubs eyes frequently
• sensitive to light
• teary eyes (reflex tearing)

Health problems associated with dry eyes include inflammatory, nutritional and endocrinological causes.

Inflammatory Causes

Inflammatory causes such as Sjogren’s syndrome, juvenile arthritis, and graft-versus-host disease (GVHD, i.e. after bone marrow transplantation) can decrease tear production which causes dry eyes.

Sjogren’s is an autoimmune  disease characterized by excessive antibodies directed against various tissues in the body. The dry eye condition, called keratoconjunctivitis is also usually accompanied by dry mouth (xerostomia). Other symptoms include: chapped lips, arthralgia, morning stiffness, nonerosive arthritis, myalgia, muscle weakness, fatigue, depression, dry cough, and achalasia (difficulty swallowing, chest pain, regurgitation).

Juvenile arthritis (JRA) is another autoimmune disease. In autoimmune diseases, the white blood cells (WBC) lose the ability to differentiate between the body’s own healthy cells, and harmful invaders such as bacteria or viruses. The WBCs start attacking healthy tissues which causes inflammation and pain. JRA first manifests between 6  months and 16 years of age. Symptoms include swelling and pain in the joints, high fever, and enlarged lymph nodes or spleen.

Congenital Disorders

Riley Day Syndrome or Family Dysautonomia is a condition that occurs almost exclusively among people of Ashkenazi Jewish descent. Roughly 1 in 3,600 people in this population have this disease. The hallmark of this disease is alacrimia which is deficiency or absence of tear production. Other symptoms include hypoesthesia (decreased sensitivity of the cornea to trauma or pain), and corneal erosions. Systemic effects include progressive impairment of motor sensory and peripheral functions.

Cystic Fibrosis affects all secretory epithelia and can lead to dry eyes also.

Diabetes can lead to insufficient tear production due to autonomic neuropathy. This is the same process that causes peripheral neuropathy in diabetes which causes tingling and burning in the hands and feet. It also impairs the mechanism that allows the nerves on the cornea to sense dryness on the eyes, which triggers a message to the brain to produce moisture to moisturize and lubricate the eyes moist and lubricated.

Poor Nutrition

Undernutrition, diets low in iron or animal sources providing vitamin A, cystic fibrosis and other causes that interfere with nutrient absorption, can lead to Vitamin A deficiency which can cause dry eyes and even blindness. Approximately 250,000 to 500,000 vitamin A-deficient children worldwide become blind each year.

Miscellaneous Factors

Medications such as antihistamines for allergies and retinoids taken for acne vulgaris can decrease tear production.

Blink rate is reduced during computer use and video game play due to intense visual concentration. Blinking interferes with concentration by breaking up the image, so the brain slows down the blink rate to nearly one-quarter of a normal resting blink rate. This dries out the eyes.

Borderline dry eye symptoms can be exacerbated with contact lens wear, although newer generation contact lenses have moisture release agents embedded within the lens that help moisturize the eyes during contact lens wear, rather than wick away moisture from the eye’s surface.

Treating Dry Eyes

In my practice, we measure  tear quality and production, and consider your health history to customize the best dry eye management program for you or your child.

If the cause is a health problem, this should be treated first. If it is related to a medication, an alternative can be explored.

Temporary relief can be achieved with over-the-counter drops and ointments, but these last only a short while, and  flush away the body’s own tears, which are more effective than artificial tears (AT). If AT are necessary for short-term relief, I prefer non-preserved artificial tears because repeated use of artificial tears with preservatives can be chemically toxic to the eyes. There are also more effective prescription strength artificial tears, such as Fresh Kote, which mimic all three layers of tears and can promote corneal surface healing.

Other treatment options include nutritional supplementation with Omega 3 fatty acids to promote natural tear production, eating more moisture-promoting foods, anti-inflammatory prescription drops such as Restasis or prednisone, and moisture chamber glasses. Since I practice holistically, I use more natural treatment options first, then medications second.

A dry eye problem in children and adults is uncomfortable, and ultimately unhealthy for the eyes. Finding the root of the problem, and the best treatment options are important to keep your child’s eyes healthy, comfortable, and looking their best.

Elise Brisco, OD, FAAO, FCOVD

www.HollywoodVision.com